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General NPI Number Information
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NPI Number | 1376219808
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Entity Type | Organization
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Legal Business Name | SPRINGLIGHT ST.MARY'S ACUPUNCTURE AND HERBS, INC.
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 6055 MERIDIAN AVE STE 30
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City | SAN JOSE
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State | CA
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Zip | 95120-2700
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Country | US
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Telephone | 408-966-5871
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 FLOWER GARDEN LN
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City | SAN JOSE
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State | CA
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Zip | 95124-6413
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Country | US
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Telephone | 408-966-5871
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | MR. CHONGHOON PAK
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Credential | ACUPUNCTURIST
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Telephone | 408-966-5871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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